Why This Article Exists
Ambient voice scribes promise to save clinicians significant time by converting consultations into structured notes using AI. Many practices are exploring these tools, and ICBs are asking questions about clinical safety.
This article shows how to apply DCB0160 specifically to ambient scribe deployment. It assumes you understand the basics—if you do not, start here:
- A Simple Guide to DCB0160 – Understand the standard
- What is a Clinical Safety Officer? – Learn about the CSO role
- How to Conduct a DCB0160 Assessment – Understand the assessment process
- What is a Digital Clinical Safety Management System? – Build the framework
The Wider Opportunity
Your ICB may have prompted you to assess your ambient scribe. Use this as an opportunity to get your wider clinical safety governance in order.
Most practices have deployed multiple digital systems over the years—electronic patient records, online consultations, prescribing tools, clinical decision support—without formal DCB0160 assessments. This is common, but it is not compliant.
The vendor's DCB0129 compliance ensures their product is safe as designed. Your DCB0160 assessment ensures it is safe as deployed in your specific practice, with your workflows, staff, and patients. Both are legally required.
Start with your ambient scribe, but plan to assess your other systems systematically. See How to Build a Clinical Safety Management System from Scratch for guidance on prioritizing systems.
Who Leads the Assessment?
Your Clinical Safety Officer (CSO) leads the assessment. For ambient scribe deployment, the CSO should ideally be:
- A GP partner or senior GP who understands consultation workflows
- Currently registered with the GMC
- Trained in clinical safety (or working towards it—see the pragmatic approach in How to Build a Management System)
- Given authority to pause deployment if safety concerns arise
If you do not have a CSO, see Setting Up a Clinical Safety Officer Role Without Extra Headcount.
Time Required
Based on typical implementations, expect these time commitments:
CSO Time
- Initial assessment and setup: 8-12 hours (spread over 2-3 weeks)
- Pilot phase: 4-6 hours per month for 3 months
- Ongoing monitoring: 2-4 hours per month once stable
Practice Manager/Admin Support
- Setup and documentation: 4-6 hours
- Ongoing: 1-2 hours per month
These estimates assume good vendor DCB0129 documentation. Poor vendor support can double these times.
The Three Main Risk Categories
Ambient scribes introduce three broad categories of clinical risk:
1. Medication Errors
The AI mishears or misinterprets medication names, doses, routes, or durations. Examples:
- "Zantac" heard as "Xanax"
- Dose recorded incorrectly
- Allergy not captured, leading to contraindicated prescription
2. Wrong Follow-Up Actions
The AI fails to capture or misrecords referrals, investigations, or safety-netting advice. Examples:
- Necessary referral not recorded
- Investigation ordered incorrectly
- Follow-up timing wrong or omitted
3. Inaccurate Clinical History
The AI misrecords history, examination findings, or diagnostic certainty. Examples:
- Critical symptoms missed or downplayed
- Examination findings inaccurate
- Diagnosis recorded at wrong certainty level
- Critical status not captured (pregnancy, safeguarding concerns)
For a detailed guide on identifying hazards, see How to Conduct a DCB0160 Assessment.
Controls That Work
For each risk category, implement proportionate controls:
Medication Safety Controls
- Clinician review: All prescriptions require explicit GP review and authorization before issue
- Decision support: Integrate allergy checks and drug interaction alerts
- Read-back protocol: Clinician confirms medication changes verbally with patient
- Secondary checks: Reception or pharmacy verifies prescription matches consultation
Follow-Up Action Controls
- Structured workflows: Use templates for referrals and investigations separate from free text
- End-of-consultation checklist: Ensure all actions are captured
- Admin validation: Admin team confirms referrals are processed correctly
- Safety-netting templates: Standardized safety-netting advice for red-flag symptoms
Clinical History Controls
- Structured symptom capture: Use red-flag symptom checklists
- Clinician review: GP reviews AI-generated history before finalizing
- Examination templates: Structured prompts reduce reliance on free text
- Critical status prompts: Explicit prompts for pregnancy, safeguarding, capacity issues
The key principle: AI suggests, clinician reviews and decides.
The Assessment Process
Follow the standard DCB0160 assessment process:
- Request vendor DCB0129 documentation: Get their safety case, hazard log, and evidence of their CSO
- Identify ambient scribe-specific hazards: Use the three risk categories above as a starting point, add any specific to your workflows
- Assess risks: Score likelihood and severity for each hazard
- Design controls: Identify what will reduce risks to acceptable levels in your practice
- Pilot with close monitoring: Start with 1-2 clinicians, monitor daily, iterate quickly
- Document your safety case: Record hazards, controls, residual risks, and CSO approval
- Roll out gradually: Expand in phases, continuing to monitor
Expect the full process to take 8-12 weeks from initial assessment to full deployment.
Pilot Phase Critical
Do not deploy to all clinicians immediately. A proper pilot phase:
- Starts small: 1-2 clinicians for 2-4 weeks
- Monitors closely: Daily review of outputs for errors or near misses
- Iterates rapidly: Fix workflow issues and control failures immediately
- Collects feedback: Clinicians report what works and what does not
- Confirms controls work: Evidence that controls are being followed and are effective
Only expand after the pilot confirms your controls work in practice.
Common Pitfalls
Pitfall 1: Treating DCB0160 as Paperwork
Clinical safety is not a compliance exercise—it is about preventing patient harm. Involve frontline clinicians in hazard identification so controls match reality.
Pitfall 2: No CSO Time Allocated
If the CSO has no protected time, the assessment will not happen properly. Block diary time and name a deputy to cover leave.
Pitfall 3: Missing Vendor Documentation
Make DCB0129 documentation a contractual requirement before you sign. If the vendor has not done their work, you will have to do it for them.
Pitfall 4: Assuming Vendor Has Addressed All Risks
Vendors assess product safety. You must assess deployment safety in your specific context with your workflows and patient population.
Pitfall 5: No Monitoring After Deployment
Controls only work if they are followed. Monitor continuously to ensure controls are effective and identify emerging risks.
Practical Scenario: Broadwater Medical Centre
Broadwater appointed a GP partner as CSO (0.1 WTE protected time). They requested the ambient scribe vendor's DCB0129 documentation, which identified 15 hazards.
The CSO conducted a deployment-specific assessment, identifying an additional 8 hazards related to Broadwater's workflows. Key controls included:
- All AI-generated prescriptions require explicit GP review (enforced by system workflow)
- Structured safety-netting templates for common presentations
- Daily review of pilot phase outputs by CSO
- Monthly audit of 10 random consultations for control effectiveness
They piloted with two GPs for four weeks, identified three workflow issues (fixed within two weeks), then rolled out to all clinicians over eight weeks.
Total CSO time: 14 hours over 12 weeks. The practice now has a working ambient scribe deployment and a clinical safety management system they can apply to other tools.
Action Checklist
- Appoint a Clinical Safety Officer with protected time
- Request vendor DCB0129 documentation (safety case, hazard log, CSO evidence)
- Conduct DCB0160 assessment specific to your deployment
- Design controls for medication, follow-up, and history accuracy risks
- Run a monitored pilot with 1-2 clinicians for 2-4 weeks
- Document your safety case and obtain CSO approval
- Roll out gradually with ongoing monitoring
- Plan to assess your other digital systems systematically
Resources to Bookmark
- How to Conduct a DCB0160 Assessment – Step-by-step process
- What is a Clinical Safety Officer? – The role leading your assessment
- How to Build a Clinical Safety Management System – Set up the framework
- DCB0160 Standard (NHS England)
Key Takeaways
Deploying ambient voice scribes safely requires applying DCB0160 systematically. The three main risk categories are medication errors, wrong follow-up actions, and inaccurate clinical history.
The key principle is AI suggests, clinician reviews and decides. All controls must integrate into clinical workflow and be monitored continuously.
Use this deployment as an opportunity to establish clinical safety governance across all your digital systems. Start with the ambient scribe, then work through your other systems systematically.